One year trends in the gram-negative bacterial antibiotic susceptibility patterns in a medical intensive care unit in South India

Abstract

Purpose: To describe the changes in antibiotic susceptibility patterns of common intensive care unit pathogens with time from the medical intensive care unit of a tertiary care hospital. Methods: A prospective observational study was conducted in the medical intensive care unit (MICU) of a 2100 bed tertiary care hospital in South India. All data regarding patient characteristics, disease characteristics, infective agents, identiÞ ed along with their antibiotic sensitivity patterns and patient outcomes were prospectively recorded in MICU data base. Various bacterial pathogen antibiotic sensitivity patterns from August 2004 to May 2005 were prospectively documented. During this period 491 patients were admitted to the MICU. Data were analyzed using excel spreadsheets. Results: Ceftazidime resistance reduced in Klebsiella spp. while cefotaxime resistance increased. In E. coli however, ceftazidime and cefotaxime resistance increased. Klebsiella resistance to cefotaxime and ceftazidime ranged from 25-50% and 14-91%, while E. coli resistance to these antibiotics ranged from 50-70% and 50 to 80% respectively. In Pseudomonas and the non-fermenting gram-negative bacteria (NFGNB) ceftazidime resistance decreased. Third generation cephalosporin resistance seemed to be reducing in the NFGNB, however, carbapenem resistance appeared to be increasing, possibly due to their increasing use. Conclusions: This study demonstrates the trend in antibiotic susceptibility pattern (AST) of common gram negative infections seen in intensive care units. It demonstrates the changes seen especially after a change in the protocol antibiotic. Changes in the AST patterns of Klebsiella, E. coli, Pseudomonas and non-fermenting gram negative bacteria were seen. The data on the changing antibiotic susceptibility trends we believe is an important pillar in our efforts at infection control especially in intensive care settings.

The Impact of Policy Guidelines on Hospital Antibiotic Use over a Decade: A Segmented Time Series Analysis

“…This could be due to the increasing use of antibiotics such as piperacillin-tazobactam for multi-drug resistant hospital acquired infections, especially in critical care settings [6]. To tackle the problem of Extended Spectrum Beta Lactamase (ESBL), there has been decreased use of third and fourth generation cephalosporins for culture confirmed cases showing no ESBL.…”

“…Resistance is not only rapidly spreading in hospitals in the cities, but also in the community and in rural areas [5]. The effectiveness of even life saving antibiotics have diminished with Escherichia coli resistance to ceftazidime and cefotaxime as high as 70% and 80% respectively [6] in intensive care settings.…”

Negative frequency dependent selection on plasmid carriage and low fitness costs maintain extended spectrum β-lactamases in Escherichia coli

“…Important caveats here are that continuous selection from antibiotic usage can favour the transfer of genes to the chromosome, and this has been documented for E. coli 22–24 . In addition, data on prevalence of ESBL genes in Asia suggests that the frequency of these genes can reach very high levels (50–70%) under strong selection 25 .…”

Antibiotic susceptibility pattern in urinary isolates of gram negative bacilli with special reference to AmpC β-lactamase in a tertiary care hospital

“…[12‐14] The above difference may be due to the geographic variations that were observed in the different strains of gram negative bacilli. In present study, 69.51 % of gram negative isolate producing β-lactamase enzymes, so they are resistant to β-lactam group, but here simultaneously AmpC β-lactamase enzyme is also detected.…”